Frontotemporal Dementia

Frontotemporal dementia (FTD) affects the brain in frontal and temporal lobes, which control planning and judgment; emotions, speaking and understanding speech; and certain types of movement.
FTD includes a range of specific disorders with different core symptoms. But there’s significant symptom overlap, especially as these disorders progress. The age of onset is 50‘s or early 60’s. It’s also known as Pick’s Disease.

SymptomsCausesTypesPrognosisDiagnosisTreatmentPreventionTips for Caregivers

Symptoms vary as per the different types, however, as the illness progresses there is an overlap of all these symptoms.

  • Increasingly inappropriate actions
  • Loss of empathy and other interpersonal skills
  • Lack of judgment and inhibition
  • Apathy
  • Changes in eating habits, predominantly overeating
  • Lack of awareness of thinking or behavioral changes
  • Speech and language problems
  • Movements related issues

Pathologically, subtypes of FTD are defined based on the pattern of protein accumulation in the brain. Few researchers believe that it’s associated with deposition of Tau proteins. Those defined as tau positive cases show inclusions made of insoluble aggregates of the microtubule (MT)-associated protein tau.

These are three major types of FTD.

  • Behavioral variant frontotemporal dementia (bvFTD) is the most challenging form. It begins with loss of motivation then progresses to disinhibition and change in personality
  • Primary progressive aphasia (PPA) affects language skills in early stages, but often also affects behavior as it advances. The two chief forms of PPA have somewhat different symptoms:
    • In semantic dementia, people speak easily, but their words convey less and less meaning. Language comprehension also declines.
    • In progressive nonfluent aphasia, people lose their ability to generate words easily. Ability to read and write also may be impaired.
  • FTD movement disorders affect certain involuntary, automatic muscle functions. The two primary FTD movement disorders are:
    • Corticobasal degeneration (CBD), which causes tremors, lack of coordination, and muscle rigidity.
    • Progressive supranuclear palsy (PSP), which causes walking and balance problems, frequent falls and muscle stiffness, especially in the neck and upper body. It also affects eye movements.

FTD inevitably gets worse, usually over several years. In advanced FTD, people typically become bedridden and unable to speak or respond. FTD shortens lifespan. Studies suggest that most people with FTD survive an average of six to eight years, but survival can range from two to 20 years.

Diagnosis involves comprehensive approach. As for other kind of dementia, mostly this depends on detailed clinical history. Magnetic resonance imaging (MRI) often plays a key role in diagnosis because it can detect shrinkage in the brain’s frontal and temporal lobes, which is a hallmark of FTD.

Management of the condition requires multidisciplinary approach.

  • Rehabilitation to restore as much mental or physical ability as possible
  • General and symptomatic management with the drugs licensed for dementia
  • Diagnosis and treatment of any underlying disease such as high blood pressure (hypertension), high cholesterol, or diabetes
  • Speech and language therapy to help the person make the best use of their remaining abilities
  • Occupational therapy to help the person cope better and more safely at home

The only risk factor known for FTD is the family history, hence not much preventive strategies have been defined.

Taking care of person with FTD can be extremely stressful due to the challenging behaviours and since it affects the person at a very young age it can make the situation worse.

  • Try joining a support group, this may help to get some useful and practical tips from other carers who have been in the same situation
  • Day care option can be explored to get a break
  • Approach professionals for management of cognitive decline and behaviours
  • When unable to take care, look for institutional facilities
Current Category: Frontotemporal Dementia
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